This thread is meant to be a basic resource for pandemic preparation and survival. As such all are welcome to add useful references and correct any incorrect information.

I started this thread after reading this book. I highly recommend any one planning for a pandemic to read it. The Great Influenza: The Epic Story of the Deadliest Plague In History by John M. Barry. ISBN 0-670-89473-7 Link to on line version

I then saw the movie Contagion and realized they based the story off the 1918 pandemic and simply modernized it. So I decided to do the same thing for this post.

It is worth nothing that historically pandemics have happened many times and have lead to significant population declines and social changes. Like most SHTF events they routinely occur at the worst possible time and generally with little notice. The modern society in which we live minimizes some of the risks through medical knowledge and superior communication, but at the same time we facilitate further pandemics since practically anyone can be in any part of the world within 24 hours. The modern transport system provides an excellent and efficient transport method for transporting illnesses.

There are many kinds of diseases which in theory can result in a pandemic. The list of them are depressing large. Here is a link historical pandemics
Fortunately one huge and chronic killer, small pox, is now officially extinct. Others such as Yellow Fever ( a big historical killer in New Orleans) are likewise under control in most areas of the world. However, others like cholera, typhoid, typhus and hepatitis among others are simply a natural disaster away. Others like influenza attack each year with varying mortality and cases.

I intend to use the 1918 pandemic as the background for this thread since it was both devastating and most recent. Clearly the preparation for a biological/chemical attack, resurgence of small pox and/or other much more virulent forms of viral/bacterial agents may require more robust and different preparations; however the basics of transmission, prevention and sanitation are similar.

1918 Flu Pandemic

The 1918 Flu Pandemic while occurring almost 100 years ago and still provides us with several lessons and thus worth the time to study. The key take home fact is that this pandemic killed over 100 million people worldwide, ( about 3%+ of the world’s population) 25 million died in the first 25 weeks. Some countries/locations were hit much harder than others. For instance 90% of the entire population of the Island of Western Samoa was infected 30% of adult men, 22% of adult women and 10% of children died whereas nearby American Samoa which enacted a unilateral embargo to prevent visitors had no cases reported. Notice the large number of adult male deaths.

The influenza’s origin has not been proven conclusively; Fort Riley Kansas, France, China, Boston and Austria have been attributed as the origin by different researchers. However in my opinion I think we should concentrate on the effect and not the origin.

The influenza came in two waves, with the second wave being much more deadly than the first. The interesting thing is that the young and healthy had a higher mortality rate. This has been attributed to the flu’s method of attack which is a cytokine storm. I will let those with more medical knowledge explain it, but simply put it turns the person’s immune system against itself, thus the stronger the immune system the stronger the attack. Youth, health and vigor offered little protection. The First World War was ending and between the stress from the war and close quarters of army camps and the trenches provided a nice incubator for the influenza. Couple this with troopships taking troops to all points in the world and you combine a great incubator with an efficient transport system.

The resulting casualties were startling. The influenza showed up in the US in force in the port cities. 99% of the pandemic influenza deaths occurred in people under 65, and more than half in young adults 20 to 40 years old. The death rate was around 20% of those who were infected. The other group that suffered heavily was pregnant women. The symptoms were also unusual and many cases were initially diagnosed as dengue, typhoid or cholera. There was bleeding from the ears, intestines and stomach but bacterial pneumonia and hemorrhaging were the primary causes of death. People in effect drown from fluid in the lungs.

The scene in many places was apocalyptic: overcrowded hospitals, mass graves, commerce stopped, municipal auditoriums used as makeshift hospitals, grave diggers too sick to bury the dead, health care professionals abandoning their posts. In short, everything that you would expect, except perhaps the collapse of society which worldwide with few exceptions continued. The First World War was over and this caused quite enough turmoil in and of itself with the downfall of royal and imperial dynasties all over Europe and Russia. Thus I suppose the turmoil was already underway.

Transmission of the Disease

A lot of illnesses have a time frame when the person exhibits no symptoms but is contagious. You feel good but you are spreading the illness.

A book could be written on the stories of transmission of the influenza, in fact many have. I will again boil down the commonly accepted transmission points by looking at the Fort Riley, Kansas incident. A cook reported sick and within days 522 men were ill with the influenza. Clearly the cook inadvertently spread the disease to these people after first being infected by someone. Spreading the influenza was easy for the cook the mess hall was crowded and the men ate in close proximity to one another. In addition it is likely that sanitation (hand washing, hair nets gloves, etc.) was not very good.
In short close proximity to people where people can breath, sneeze or otherwise pass along the illness through contact with contaminated surfaces. People frequently rub their eyes, touch their face, pick their nose and put their fingers in their mouth. If your hands have been in contact with a contaminated surface or person and then for whatever reason rubs their eyes, nose or mouth, they have effectively permitted a path for the illness to intrude. Other illnesses can be transmitted in aerosol form, i.e. coughing and sneezing.

The influenza thrived in the barracks, the troop ships, the prison camps and military bases. Remember all military bases even then had a lot civilian resources coming in every day to provide food, supplies and any number of necessary items. These civilians also delivered the good s and services to others thus providing a means to spread the influenza quite effectively.

Ports of entry, railway hubs and other transport zones experienced more cases than other areas. In 1918 there were no interstate highways and relatively few cars per capita. But the patterns were clear transport choke points then points where people congregated were the primary and secondary transmission points. These included passenger ship docking terminals, railway terminals, the bars, restaurants and hotels that normally pop up around these points followed by the hospitals, stores, schools, theaters and any enclosed place where people congregate.

The other thing that stuck me was the truly random nature of many of these transmission incidents. It was for many, a matter of being in the wrong place at the wrong time. It is clear that random chance played a part in many of these incidents

So What Should We Do to Prepare?

Intelligence: An epidemic is not likely to give any warning and in fact for a true pandemic to occur, unless we work in the field, we probably will not know about it until it is well underway. Obviously governmental sources are useful to provide information. Yes (for those with tinfoil) it can be a source of possible disinformation but there are several sources that can be consulted and at least provide “official” information.

Vaccinations: I know there are people who will disagree but in my opinion staying current on vaccinations is a great way to keep many of the more common nasties at bay. However, it is very unlikely that any illness for which there is a vaccine will turn into a pandemic. There may be a vaccine made later but initially there is unlikely to be one. Think about it; it is difficult for a bug to spread if there are a lot of people immune to it. Another pandemic is more likely to be a variation of one of the influenzas or other illness that does not presently have a vaccine. Thus vaccines while sensible are unlikely to offer any protection.

Hygiene: After reading about the pandemic I started paying more attention to washing hands and disinfecting eating utensils. However, I do not want either you or me to turn into Howard Hughes and demand Kleenex covering all our food. That said this seems to be a very effective way to reduce the probability of catching colds and other ordinary illnesses. You do not have to be obsessive about it but simple hand washing and basic sanitation will go a long way to preventing illness. Hand sanitizers are not really necessary and plain soap and water will work quite well . Though hand sanitizer is a good substitute if you do not have access to clean water.
Decontamination of food utensils is equally simple. The use of hot water and soap in the dishwasher is generally adequate to eliminate viruses like influenza. Use the hot dry option and that pretty much ensures that eating utensils will be safe for your use.

Clothing likewise is generally fairly easy to deal with as long as you have soap and hot water.

Avoidance: This is actually a great strategy. The CDC and WHO both suggest avoiding ill people, stay 6 to 10 feet away from them and in general avoid confined spaces where there are sick people. The problem with this strategy is that you have to stay locked up in your house and avoid airports, public transport (buses/trains/planes), supermarkets, shopping centers or otherwise anyplace where people congregate. That sounds more like a prison than a life. However it can be a good strategy to avoid infection. In the event of a breakout this strategy is IMO the key strategy to implement. A bug in is likely to be a very good defense. Obviously a bug in assumes you have supplies in your BIL to stay inside for a prolonged period.

Personal Protective Equipment (PPE): PPE for a pandemic would in many cases be a simple N-95 mask, glasses long sleeve shirt and pants with shoes and gloves. Obviously HAZMAT responders, lab techs, primary care providers and people in close proximity to sick people will need specific protocols. However for the average person this basic PPE and distance is likely to be effective. I would also note that the CDC in its protocols considers PPE the 4th in importance. The logic is that PPE is the last ditch defense and to be used only if other protocols fail.

Personally when I reviewed my equipment I included some disposable tyvek suits and booties. I also include PVC rain gear and boots which I would wear over my regular clothes to make decontamination easier by leaving the outer gear outside of my living areas. However, after reading the CDC protocols I now consider this overkill…but I will keep it in the kit.

I would note that the official opinion is that face masks may or may not be useful.

I would note that while the evidence that a face mask can prevent infection in everyday situations is limited; the evidence is solid that when it comes to care givers. It has been demonstrated that the use of face masks cuts the exposure risk significantly when coupled with routine hand washing for caregivers taking care of family members. The key variable in face mask effectiveness was the lack of training and the resulting improper use of the mask. If you buy masks learn how to properly fit them and practice with them.

The key take away here is that N-95 masks are useful, but they are not a panacea. Simply washing your hands and avoiding touching your eyes, nose and mouth with your hands will likely be as useful as a mask. That is not to say you should not stock face masks; only that access to soap and clean water is also just as critical. If these are not available use a hand sanitizer that contains at least 60% alcohol..

Prepare to Get Sick : Obviously the primary goal is not get sick in a pandemic. That said the secondary goal is survive the illness if you do contract the illness. You also may be lucky enough to avoid the illness but that may not be case for a loved one. You may need to be the caregiver. Remember in a pandemic hospitals will be overloaded and medical care may not be available. It may also require that you go to a hospital or makeshift hospital filled with people sick from the pandemic only to wait several hours for access to an overworked medical professional who may not be able to do anything beyond providing palliative care. Thus if you are healthy you risk getting infected for no effective assistance. This is a poor choice.

A person who is contagious should be isolated from the rest of the family. They should be as far away from
the rest of the family as physical possible and comfortable. You should clean the sheets, clothing and dinnerware separately from the others. The caregiver should wear a mask and wash hands before and after providing care. The ill person should stay in the room or if they must leave the room (say to use the bathroom) make sure they are provided with a face mask to minimize the contamination to the rest of the house.

You should review your FAK to ensure that you have decongestants, expectorants and over the counter cold and flu medicine. These obviously treat only symptoms but that may be better than nothing. You may, after consulting with your doctor, want to acquire some Tami flu and other specific prescription drugs to take if you are exposed to likely risks. You should also have on hand basic hydration materials to combat dehydration. I assume you already have a decent FAK with analgesics and wide variety of medications, prescription and other wise. You want to be able to take care of an ill person for a minimum of 10 days, obviously more is better.

Other Useful Links

Cities With High levels of International Travelers and Thus More likely have Infected Travelers

You can set this to app track specific diseases or leave it on default for all tracked. Each alert leads to a related story for details - enjoy, but if you miss any sleep, it's not my fault... You've been warned.

raptor wrote:This thread is meant to be a basic resource for pandemic preparation and survival. As such all are welcome to add useful references and correct any incorrect information.

I started this thread after reading this book. I highly recommend any one planning for a pandemic to read it. The Great Influenza: The Epic Story of the Deadliest Plague In History by John M. Barry. ISBN 0-670-89473-7 Link to on line version

I second the book recommendation! One of my main reads when we did pandemic planning at my last job in 2006-7, prompted by bird flu.

raptor wrote:Intelligence: An epidemic is not likely to give any warning and in fact for a true pandemic to occur, unless we work in the field, we probably will not know about it until it is well underway.

Actually, for the H1N1 outbreak, the CDC and public health announcements got to my area before there was any major H1N1 activity. This will depend on geographic luck - but if the epicenter is not by you, you may get warning. My professional notifications were not significantly in advance of what was on the news, altho it was a LOT less sensational and more specific. I don't work for WHO or CDC or anything, but CDC works with state health departments, and IME they've been pretty good about disseminating to health care providers. And we talk a lot . I would have had plenty of time to implement the split bug out/bug in family pandemic plan if the mortality rate had been high. (I would have bugged out to the hospital and stayed there, so as not to bring it home. Husband would have bugged in with kids so as not to catch.) And I was watching the news/info like a hawk that first week, until more data was in, to see if I needed to. I was going to point to the email alerts I signed up for from the Minnesota Department of Health - but they took them off the public website since I signed up.

raptor wrote:Vaccinations: I know there are people who will disagree but in my opinion staying current on vaccinations is a great way to keep many of the more common nasties at bay. However, it is very unlikely that any illness for which there is a vaccine will turn into a pandemic. There may be a vaccine made later but initially there is unlikely to be one. Think about it; it is difficult for a bug to spread if there are a lot of people immune to it. Another pandemic is more likely to be a variation of one of the influenzas or other illness that does not presently have a vaccine. Thus vaccines while sensible are unlikely to offer any protection.

Only one caveat to this - one of the other ways influenza kills is by secondary bacterial infection, commonly pneumonia. So if you're indicated for pneumococcal vaccine, that might help reduce (not eliminate) the chances of that.

raptor wrote:Avoidance: This is actually a great strategy. The CDC and WHO both suggest avoiding ill people, stay 6 to 10 feet away from them and in general avoid confined spaces where there are sick people. The problem with this strategy is that you have to stay locked up in your house and avoid airports, public transport (buses/trains/planes), supermarkets, shopping centers or otherwise anyplace where people congregate. That sounds more like a prison than a life. However it can be a good strategy to avoid infection. In the event of a breakout this strategy is IMO the key strategy to implement. A bug in is likely to be a very good defense. Obviously a bug in assumes you have supplies in your BIL to stay inside for a prolonged period.

This may be a little more like a zombiepocalypse bug in, if it gets really bad. This is what got me prepared for long term power and water outages, and got some cash and gas on hand - the linemen and utility folks will get sick too, or bug in and not report to work. Ditto the Brinks truck guys, and the guys at the refinery, and the ones who drive the tanker trucks. Ice storms will happen at the worst possible times. Even if your employer is still doing business, and you're still able to work, they may not be getting paid, and making payroll may become a problem.

raptor wrote:Avoidance: This is actually a great strategy. The CDC and WHO both suggest avoiding ill people, stay 6 to 10 feet away from them and in general avoid confined spaces where there are sick people. The problem with this strategy is that you have to stay locked up in your house and avoid airports, public transport (buses/trains/planes), supermarkets, shopping centers or otherwise anyplace where people congregate. That sounds more like a prison than a life. However it can be a good strategy to avoid infection. In the event of a breakout this strategy is IMO the key strategy to implement. A bug in is likely to be a very good defense. Obviously a bug in assumes you have supplies in your BIL to stay inside for a prolonged period.

This may be a little more like a zombiepocalypse bug in, if it gets really bad. This is what got me prepared for long term power and water outages, and got some cash and gas on hand - the linemen and utility folks will get sick too, or bug in and not report to work. Ditto the Brinks truck guys, and the guys at the refinery, and the ones who drive the tanker trucks. Ice storms will happen at the worst possible times. Even if your employer is still doing business, and you're still able to work, they may not be getting paid, and making payroll may become a problem.

Fantastic topic, info, and links, as always!

Great thread -
My 2 cents on avoidance - it is going to be very hard to identify just when you lock down - least I think it will be - at what point do you say "I'm going to risk loosing my job by staying in my house to minimise infection and exposure?"?

H5N1 in humans has a mortality rate of nearly 60% ...I find that rather sobering to think about.

I was traveling at the beginnig of the Swine Flu out break from South-West England to Alaska for a funeral - via Amsterdam and the Twin Cities. That was a rather interesting experience and certainly gave me a first hand insight into just how quickly these things could travel. A fair few people had masks - I just was extra careful with washing my hands.

duodecima wrote:
Only one caveat to this - one of the other ways influenza kills is by secondary bacterial infection, commonly pneumonia. So if you're indicated for pneumococcal vaccine, that might help reduce (not eliminate) the chances of that.

Excellent point. I travel a lot so keep my pneumonia shots up to date. Interesting thing is that if you are not considered as old or in healthcare you get a lot of questions as to why you want the shot.

The problem there is that everyone isn't getting vaccinated. The potential for an unvaccinated individual to get something we're vaxxed against and it to mutate into a new strain has possibilities to result in a pandemic.

duodecima wrote:
Only one caveat to this - one of the other ways influenza kills is by secondary bacterial infection, commonly pneumonia. So if you're indicated for pneumococcal vaccine, that might help reduce (not eliminate) the chances of that.

Excellent point. I travel a lot so keep my pneumonia shots up to date. Interesting thing is that if you are not considered as old or in healthcare you get a lot of questions as to why you want the shot.

I agree completely with this logic. I personally keep up to date on all vaccines, since I travel a lot. My negative comments about vaccines were not directed these vaccines. I was simply trying to point out that a vaccine for the "pandemic du jour" is not likely to be available immediately.

the_alias wrote:
My 2 cents on avoidance - it is going to be very hard to identify just when you lock down - least I think it will be - at what point do you say "I'm going to risk loosing my job by staying in my house to minimise infection and exposure?"?

This is IMO the biggest problem for a prepper. At what point do you say I am staying home? The sooner you do it the better your chances. However, using this logic you may never leave your home. It is striking that balance of sensibility and safety that poses the problem....where is that line?

Each of us also has different issues. Having kids in school as any parent knows is a great way to bring illness into the family. No kids in school means less risk. If you work at a retail job and exposed to people you are at greater risk than someone who works in a single occupant office.

That is something that we should each consider in our preparations.

Last edited by raptor on Wed Sep 21, 2011 10:34 am, edited 1 time in total.

Last time there was a flu scare, one of the major concerns of health officials was that there wouldn't be enough ventilators for all the patients... some cities were even preparing "rationing" plans to decide who would get a ventilator and who wouldn't.

To get a weekly email of US Army unclassified health threats, send an email to USACHPPM-HIOProgram@amedd.army.mil with the subject, "Subscribe to Army Public Health Weekly Update". It's not much better than looking at the Google News subsection for health but there's some good stuff in there some weeks.

I can't find the article, a couple flu seasons ago they started issuing hand sanitizer to all the Army basic trainees and the drill sergeants would frequently command their units to use it. They had great results in reducing the number of sick trainees.

Also somewhere in my memory I am recalling that the Army told me my seasonal flu shot would offer me some level of protection against H1N1 two years ago when it was going around and we didn't have enough of the vaccine to go around initially.

In my family, anytime we come home from work/school we leave our shoes in an entry area and then wash or sanitize our hands before proceeding to the rest of the home.

And one other piece of trivia that comes to mind: hand sanitizer does not kill C.Diff. I remember working on a ward with a patient who had C.Diff and everyone out of habit was using the hand sanitizer... thereby contaminating it with C.Diff.

Bonecrusher Doc wrote: I'd say this has at least a little justification as a mental exercise.

JamesCannon wrote:Yes, well there's the right way and wrong way to exercise, and the wrong way can lead to injury and/or damage.

Bonecrusher Doc wrote:
And one other piece of trivia that comes to mind: hand sanitizer does not kill C.Diff. I remember working on a ward with a patient who had C.Diff and everyone out of habit was using the hand sanitizer... thereby contaminating it with C.Diff.

This is a great little nugget of information. Thank you for sharing some first hand issues like this!

In this case the hand sanitizer became the vector source. If you think about it everyone who thinks they have dirty hands hits the hand sanitizer and assumes their hands are clean after using it.

This is all very interesting to me I'm reading this book right now http://jakartapandemic.com/" onclick="window.open(this.href);return false; and it's really opened my eyes to this whole pandemic thing. I honestly had figured what I now know to be erroneous thinking that we'd wiped out this type of stuff year ago and it was now no big deal. This topic is very timely and I'm going to be reviewing it with great interest.

Raptor,
Another excellent post as always, thank you!
Not that I am a true germophobe, but I was known to chase my installers out of my office, with a can of Lysol, if they happened to come into my office and were sick.
A flu-like pandemic is a concern of mine, especially after the considerations of Contagion. (LOVED the movie!)
I have a reading project to start now

ETA: Meh! I was reading and saw that some pages are omitted from the book preview, I guess I will be heading to the library.

Thinking back again to two years ago, I attended a 1 hour lecture on the then-developing flu. The subject-matter-expert said the big killer with that flu was the pneumonia, and that while with some flu symptoms your best choice may be just to stay at home, if you develop SHORTNESS OF BREATH to go to the doctor immediately (tell the doctor "I have flu symptoms and shortness of breath"), because once you develop shortness of breath you can be DEAD IN HOURS from the pneumonia and it may already be too late. The personal story he related was that his own daughter called him and said she thought she was getting the flu, and at the time the only vaccine available was the nasal spray which she couldn't have because she was pregnant. He told the audience that he told his daughter not to worry, just to stay home and get rest and plenty of fluids but to go to the doctor IMMEDIATELY if she got shortness of breath.

Of course different germs can give you different symptoms and another big killer that could come with a future pandemic is diahrhe diahhre eh you know what mean. I suggest if you don't include pre-packaged oral rehydration powder in your preps to stock up on the ingredients for it and print out the recipe. Cheap lifesaving prep!

Caveat: I'm not a physician, I just hang out with physicians a lot.

Bonecrusher Doc wrote: I'd say this has at least a little justification as a mental exercise.

JamesCannon wrote:Yes, well there's the right way and wrong way to exercise, and the wrong way can lead to injury and/or damage.

I am still increasing my supply of N-95 masks, even if they aren't functionally as effective as washing my hands. I think they do help me from touching my nose and mouth as much. Combined with my glasses I reduce my absent minded hand to face touches. They aren't comfortable for long stretches, but when I am moving thru an environment where I touch doors, railings, elevator buttions, etc., the mask helps me refrain from transferring any stuff to my face until I can get my hands washed. My breath can get them pretty moist after a while, so I always carry some extras with me. And no, I'm not a germaphobe. I did wear them during a week of two of the last H1N1 scare when I had reached my personal "I think its time to wear a mask in public" level of concern.

- Flash

Browncoat, food & H2O storing Dad. "I don't care, I'm still free, you can't take the sky from me."
"Freedom is not a gift bestowed upon us by other people or the majority, it's a right that belongs to all of us."

FlashDaddy wrote: My breath can get them pretty moist after a while, so I always carry some extras with me.

They make N-95 with a exhale valves. I find these far more comfortable for long term wear.

I think the studies show they are effective, especially if you are a caregiver. It is just for most people that hand washing is more effective. It is my intention if the situation arises to both increase the frequency of hand washing in combination with the use of an N-95 mask and gloves.

Raptor, awesome thread. Good reading and lots of details to re-evaluate prepping.
Thanks!

A person should be able to change a diaper, plan an invasion, butcher a hog,. .., build a wall, set a bone, take and give orders, cooperate, analyze & solve problems, fight efficiently, die gallantly RHhttp://johnfoberg.blogspot.com/

"The scene in many places was apocalyptic: overcrowded hospitals, mass graves, commerce stopped, municipal auditoriums used as makeshift hospitals, grave diggers too sick to bury the dead, health care professionals abandoning their posts. In short, everything that you would expect, except perhaps the collapse of society which worldwide with few exceptions continued."

Everyone always assumes society will collapse, here is evidence that no it doesn't always. Yes these are different times but look at the big east coast blackout a few years ago. There were no riots just New Yorkers calmly walking home. Again, yes it can happen like with Katrina, but no it won't always, have a little faith in humanity but be prepared.

Second I don't know how many of you caught this a few years ago but Canadian researchers brought back the 1918 flu.http://news.bbc.co.uk/2/hi/6271833.stm" onclick="window.open(this.href);return false;
The results were every bit as bad as the historic accounts (at least on monkeys). Very interesting stuff.

Bonecrusher Doc wrote:
And one other piece of trivia that comes to mind: hand sanitizer does not kill C.Diff. I remember working on a ward with a patient who had C.Diff and everyone out of habit was using the hand sanitizer... thereby contaminating it with C.Diff.

This is a great little nugget of information. Thank you for sharing some first hand issues like this!

In this case the hand sanitizer became the vector source. If you think about it everyone who thinks they have dirty hands hits the hand sanitizer and assumes their hands are clean after using it.

I'm confused here (as a former nursing student/nursing assistant).
Wasn't the patient on precautions, meaning you had to have gloves and a gown on before entering the room?
Also for those who don't know c-diff (a bacteria) results in very bad smelling (and often explosive) diarrhea.